Health Law Expands Medicare Coverage Of Preventive Care

Preventive health care is important at any age, but never more so than as we get older. Many of the major cancers that can be screened for – such as breast and colorectal cancer – are typically diagnosed at about age 70. After age 55, people have a 90 percent chance of developing high blood pressure, putting them at higher risk for heart disease and stroke.

“The payoff in terms of prevention in geriatrics is more upfront and more immediate,” says geriatrician Peter Hollmann, chairman of the public policy committee for the American Geriatrics Society.

Starting in January, the new health-care law will make it easier and cheaper for seniors to get preventive care. Medicare beneficiaries will be able to receive for free all preventive services and screenings that receive an A or B recommendation for seniors from the U.S. Preventive Services Task Force. That includes mammograms and colorectal cancer screening, bone mass measurement and nutritional counseling for people at risk for diet-related chronic diseases such as diabetes.

Medicare beneficiaries will also get a free annual wellness visit under the new law. The visit will cover a number of services, including a health risk assessment and a review of the person’s functional and cognitive abilities.

The goal is to identify and to address declines in physical or mental capacity early on, say experts – before someone takes a fall, for example, or starts to forget to pay his bills.

Currently, seniors in traditional Medicare pay 20 percent of the cost for most covered preventive services. The new requirements for free preventive coverage don’t apply to enrollees in Medicare Advantage plans, although many of those plans already offer free preventive services.

Cost can be a big stumbling block to getting preventive care.

A co-payment of just $12 for a mammogram in Medicare’s managed-care plans resulted in screening rates that were 8 to 11 percentage points lower than those for women in plans that didn’t require a co-payment, according to a 2008 study published in the New England Journal of Medicine. Another study found that an increase of $10 in a co-payment for physician office visits led to a 20 percent decline in appointments among elderly patients.

“A lot of these screenings aren’t something somebody wakes up and says, ‘Wow, I’m going to have a flexible sigmoidoscopy today,’ ” says Cheryl Matheis, senior vice president for health strategy at AARP.

To encourage seniors to get that test, one of a number of approved screenings for colorectal cancer, and other important preventive services, “we have to educate people about the value and then eliminate the cost and make it convenient,” she says.

The new law envisions the free annual wellness visit as an opportunity for seniors to develop a “personalized prevention plan” with their physician and plot out appropriate services and screenings for the next five to 10 years.

There hasn’t been much research on people in their 80s or older, so it’s hard to calculate the risk/benefit ratio of preventive tests and screenings in this group, say experts.

“It gets a little murky when people get older,” says Hollmann. Among other things, “you have to consider their practical life expectancy.”

Many people who work with seniors hope the annual wellness visit will provide an opening to also discuss preventive activities not covered by Medicare.

“We can use it as an opportunity to educate people about community activities like healthy eating or falls-prevention programs,” says Nancy Whitelaw, a senior vice president at the National Council on Aging.

Some insurance plans offer their own programs that encourage “healthy aging.” Eight years ago, Tom Cajski joined the Kaiser Permanente Senior Summit program at a clinic near his home in Kailua, on the island of Oahu in Hawaii. Among other things, the program aims to stay in touch with seniors who are relatively healthy and don’t visit clinics often to make sure they’re getting the preventive care they need, says Sandi Brekke, who runs the program.

Every month, members attend lectures or demonstrations on health topics from foot care to acupuncture. Twice a year they get physical evaluations to test their strength, flexibility and balance, among other things.

Cajski, 73, says he thinks the program helps him take better care of his health.

“I’m surrounded by people who give me health hints and keep me thinking about something that would otherwise recede,” he says.

Advocates for seniors say the new law’s provisions make it clear that prevention is important at any age. And about time, too.

“It’s awfully nice to see Medicare catch up to where the rest of the world has been for some time,” says Hollmann.

About Insuring Your Health

Michelle Andrews, KHN contributing columnist, has been writing about health care for more than 15 years. Her work has appeared frequently in The New York Times, where she wrote the Money and Medicine column and contributed regular news and features. Her work has also been published in Money, Fortune Small Business, National Geographic and Women’s Health magazines, among others.

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Health Law Expands Medicare Coverage Of Preventive Care

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